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HIV (human immunodeficiency virus) is a virus that affects specific cells of the immune system, called CD4 or T-cells. It is spread through body fluids, with blood, semen and vaginal fluids having the highest concentrations of the virus. After some time (after initial infection), HIV can progress to destroy so many of these cells that the body can no longer effectively fight off infections and disease. When this happens, HIV infection leads to AIDS (acquired immunodeficiency syndrome).

Is there a cure for HIV and AIDS?

To date there is no cure for HIV. However, antiretroviral therapy (ART) can dramatically prolong the lives of many people infected with HIV and lower their chances of HIV transmission. It is important that people get tested for HIV to know their status early. ART and other medical treatment have the greatest positive effect if started early.

Who is eligible for ART?

Trained health workers will assess infected people and determine if they are eligible for ART. At whatever stage of the infection, health workers will advise and refer the infected person to appropriate care. Some of the groups that will be recommended for ART in Malawi include:

All HIV-infected pregnant women, in order to reduce the risk of transmitting HIV to their baby during pregnancy, child birth and breast feeding;

All babies born from HIV-infected women until viral tests prove that they were not infected during the pregnancy and breastfeeding period;

Any child above five years or adult with a CD4 cell count below 500 per mm3;

A person infected with HIV whose spouse is not infected in spite of his/her CD4 count;

An HIV-infected person who, on the informed judgement of a health worker (based on specific available criteria from the World Health Organisation), has a serious opportunistic infection in spite of the CD4 count levels.

For how long does one take ART?

ART is taken for life. It is important that people on ART adhere to instructions provided by health workers. Defaulting ART results in various undesirable outcomes such as developing infections, death and increasing the chances of transmitting to uninfected partners (or transmitting to a baby if the mother is pregnant or breastfeeding).

There are three stages of the HIV infection, namely: acute infection, clinical latency, and AIDS.

Acute infection

This stage is typically within two to four (2 – 4) weeks from the day one acquires the HIV infection. Some people may feel sick with flu-like symptoms, and this is termed primary HIV infection or acute retroviral syndrome as the body naturally responds to the HIV infection.During the acute infection stage, large amounts of HIV are being produced in the infected person’s body. The virus uses CD4 cells to make copies of itself and destroys the CD4 cells in the process, leading to a reduction in CD4 cell count. An infected person’s ability to spread HIV is highest during this stage as the amount of virus in the blood is very high.In due course, the infected person’s immune response will begin to bring the amount of virus in the body back down to a stable level and the CD4 cell count will begin to rise, though it may not return to the levels before the infection.

Clinical latency (inactivity or dormancy)

This period is sometimes called asymptomatic HIV infection. In this stage, HIV is still active but reproduces at very low levels, and the infected person may not have any symptoms or get sick. Depending on various circumstances, the period in clinical latency stage varies from one infected person to the other. Towards the middle and end of this stage, an infected person’s viral load begins to rise, the CD4 cell count begins to drop and symptoms of HIV infection begin to manifest as the immune system becomes too weak to offer protection against diseases.

People who are on ART may live with clinical latency for several decades. While ART greatly reduces the risk of transmitting HIV, it is important to remember that an infected person may still transmit the virus.

AIDS (acquired immunodeficiency syndrome)

This is the stage of infection that occurs when an infected person’s immune system is greatly weakened, leading to vulnerability to infections often called opportunistic infections. Normal CD4 cell counts are between 500 and 1,600 cells per cubic millimetre (500-1600 cells/mm3). When the number of CD4 cells falls below 200 cells/mm3, an infected person is considered to have progressed to AIDS.

One can also be diagnosed with AIDS if he/she develops one or more opportunistic illnesses, regardless of the CD4 count. Without treatment, people who are diagnosed with AIDS survive for a very short time, and with a serious opportunistic infection, life expectancy without treatment is reduced to about a year. People with AIDS need medical treatment to prevent death.

HIV is transmitted through body fluids, and sexual contact is the most common means of HIV transmission. It can also be transmitted from mother to child during pregnancy, child birth and breastfeeding.

The only way to know if one is infected with HIV is to be tested. You cannot rely on symptoms to know whether you have HIV. Many people who are infected with HIV may not have any symptoms at all for many years. Many health facilities (government, Christian Health Association of Malawi [CHAM], private) offer HIV testing and counselling (HTC) services for free across the country. People can even be tested at the community level –many other organisations conduct community outreach health activities that include HTC – or during HTC campaigns conducted each year.